Work-in-progress. Improving Patient AND Physician Understanding of Radiology Reports

Help us solve a conundrum! We want to teach physicians just-in-time. However, this may worsen a patient’s understanding of a radiology report. Can we make this a win-win?

from Dall-E via BING

Image above: From Dall-E via BING chat

To: patients and informatics colleagues out there:

Here is your problem of the day. Physicians and APP’s who order ultrasound tests for “screening for liver cancer” for example, have a difficult time understanding the LI-RADS categories that radiologists put into the radiology reports.

Brilliant! Our always-helpful radiology colleague recently began inserting the following just-in-time education intended for the physicians and APP’s receiving these reports:

Super! Everyone is happy. Physicians have a much better understanding of the interpretation of the report AND there is a helpful index at the bottom of same report explaining the LI-RADS category and also the Visualization score, and some sense of what to do next.

What could go wrong?

This was turned on about a year ago. A few weeks ago, one of my patients, who has full access to her EHR Patient Portal, and this immediate access to her ultrasound report, called me in a panic: “My ultrasound shows that I have POSITIVE – Observation Detected. Doesn’t that mean I have cancer? It says right here!” Fortunately, we had an upcoming in-person appointment and I asked her to bring the printout so we could discuss it.

I looked at the printout she brought in. Indeed, she had a benign appearing ultrasound report. What she was reading was the very bottom of the report that included the index of LI-RADS categories.

I then explained that this part of the report was only a reference tool for doctors and did not apply to her. After about 10 minutes of discussion, she seemed to understand, and then gave me a stern look: “This is very confusing. Why are you doing it this way?”

I took this feedback and sent it back to our well-meaning radiology colleagues, that our patients were now misunderstanding the LI-RADS explanation text intended for our physicians, and over-interpreting it to apply to themselves.

My radiology colleagues responded with the following addition in BLUE:

What do you think? Is it helpful? Is it enough?

In all of our radiology reports, that we have been sending to patients immediately for a couple years now, we have standard text that reads:

If you are a provider with questions, you can call Radiology Help Line at xxx-xxx-xxxx. If you are a patient with questions, please contact your ordering provider to discuss.

We do have an occasional patient who DOES call the Radiology Help Line, and in those rare cases, our radiologists are happy to have that discussion with patients, and patients are satisfied with those discussions.

The addition of the help text for LI-RADs is written about the patient in the 3rd person “the patient”, as opposed to the quotation above, which is written for the patient in the second person “you.

CMIO’s take? For now, the help text on LI-RADS is what our reports have included. We have had no more patient complaints registered.

What do our informatics colleagues and online patient communities think of our approach? Do you have a suggestion on how to make it better? We want our radiology reports to be a WIN-WIN: more easily interpreted by both our ordering physicians/APP’s as well as by our patients.

Author: CT Lin

CMIO, UCHealth (Colorado); Professor, University of Colorado School of Medicine

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